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Mid-Year
Benefit Changes: When Are They Permitted?
As a benefits-eligible employee, you
are typically not allowed to make changes to your benefits outside of
the usual Open Enrollment Period in July unless you experience one or
more of the following events described as a “Change in Status”
during the plan year.
- Change in Marital Status due to marriage, divorce, annulment,
legal separation, or spouse’s death.
- Change in Number of Dependents due to birth, adoption,
placement for adoption, death or gain of step children or guardianship.
- Change in Residence that causes you, your spouse, or your
dependents to be no longer eligible for the plan originally selected.
- Change in Employment Status of an employee, spouse or
dependent, such as starting or ending employment, starting or returning
from an unpaid leave of absence, a change in job status or other changes
that affect plan eligibility.
- Change in Dependent Eligibility such as marriage of your
dependent, or your dependent reaching 25 years of age.
- Cost Changes such as a mid-year increase (or decrease) in
your insurance plan’s premiums that causes you to have a significant
increase or decrease in cost.
- Change in Coverage Under Other Employer’s Plan, such as a
change in your spouse’s or dependent’s benefit plan.
- Loss of Coverage Under Certain Group Health Plans of a
Government or Educational Institution, such as a state children’s
health insurance program (CHIP), a state health benefits risk pool, or a
foreign government group health plan.
- Judgment, Decree, or Order from a legal separation, divorce,
annulment, or change in custody that requires your dependent child to be
covered under a benefit plan.
- Medicare or Medicaid Entitlement: When you, your spouse or
your dependent become eligible or (lose eligibility) under Medicare or
Medicaid.
If
you have a "Change in Status", you have the opportunity to
make changes to your benefits.
In the event that
you experience one of the “Status Changes” listed above during the
year, you will have the opportunity to make changes to your benefits as
long as all required forms are properly completed and submitted to the
Human Resources Office no later than 31 days from the date of the your
qualifying event. This
means you must:
- Notify Human Resources of your status change within 31 days
from that of your qualifying event. If your application is not completed within the 31-day deadline,
the change(s) you request will not be permitted until the next Open
Enrollment Period in July.
- Submit documentation that proves your status change occurred
such as a copy of a birth or marriage certificate, a letter from a plan
administrator or employer, a certificate of credible coverage or a HIPAA
certificate. It just
depends on your status change!
- Complete a new Group Insurance Enrollment Form and the Change
of Status Form for Mid-Year Benefit Election Changes. For certain changes, you may also be asked to submit an
application of Evidence of Insurability to add a dependent.
Once the proper
paperwork for your status change has been completed and finalized, the
changes in your benefits will become effective on the following
conditions.
- On the date your dependent becomes eligible, provided no
increase in your premium or evidence of insurability is required to add
your dependent. You must
agree to pay the required premium if you want your dependent’s
coverage to begin on the date of the qualifying event.
- If evidence of insurability is required, coverage will take
effect on the later of
1) the date your application is approved; or
2) the date of the
change in status.
- If your dropping a dependent or your coverage, the change
will take effect on the last day of the month that you paid a premium
for your coverage.
For further information or if you would like to
report a change in your status, please contact Christina Logan from the
Human Resources Office at 544-8809 or clogan@hp.utbtsc.edu.
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